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Questions & Answers About OCD In Children and Adolescents (page 2)

By — Obsessive Compulsive Foundation
Updated on Feb 18, 2011

What types of medications are used in OCD?*

Anti-OCD medications are classified as antidepressants. But, only those antidepressants affecting the brain chemical serotonin most effectively treat OCD. Serotonin reuptake inhibitors (SRIs) comprise the standard anti-OCD medications, which include all selective serotonin reuptake inhibitors (SSRIs) and one of the tricyclic antidepressants (TCA). SSRIs (citalopram/ Celexa; escitalopram/Lexapro; fluoxetine/Prozac; fluvoxamine/Luvox; paroxetine/Paxil; and sertraline/Zoloft) and the TCA clomipnamine (Anafranil) successfully treat OCD independently of their effects on depression.

The FDA placed a black-box warning to alert prescribing doctors and patients that special care be taken when any antidepressant medications are used to treat depression and other disorders such as obsessive-compulsive disorder (OCD) in children and adolescents. The FDA reported an increase in spontaneous reports of suicidal thoughts and/or behavior among children receiving medication, but there is no evidence that these suicidal thoughts or behaviors lead to an increased risk of suicide.

How do OCD medications work?

Anti-OCD medications work by affecting the brain chemical identified as serotonin. Serotonin allows certain brain cells (called neurons) to communicate with other brain cells. Anti-OCD drugs interfere with the recycling of serotonin, allowing it to spend more time outside cells, thereby affecting other cells. How or why this reduces obsessions and compulsions is not fully understood.

Which anti-OCD medication should be tried first?

Serotonin reuptake inhibitors (SRls) are important for treating acute conditions, as well as maintenance regimens in children and adolescents. All of the SSRIs work equally well, but on an individual basis one may work better than the others, requiring a process of trial and error supervised by the child’s psychiatrist. Side effect profiles or a positive family history of response may be used as a rationale for an SSRI choice. There is some indication that clomipramine may be more effective than SSRIs. However, given their preferable side effect profiles, SSRls remain the first line of medical treatment.

What are the side effects of anti- OCD medications?

SSRls have side effects that may include stomach upset, drowsiness, agitation and headaches. Rare side effects include behavioral activation in children and adolescents - mood switching to an unusually happy state or suicidal thoughts. Close monitoring by the treating psychiatrist is necessary.

What is the best medication dosage for OCD in children and adolescents?

The best dose of anti-OCD medication is determined on an individual case-by-case basis. The smallest amount of medicine that effectively treats the young person’s OCD is preferred. However, most children metabolize medications quite rapidly, and relieving OCD symptoms often requires the use of higher, adult-sized doses.

How long does it take for medication to work and what duration is recommended?

All anti-OCD medications work slowly. Medication is often first considered when the child’s OCD is severe, and both the child and family are in distress. However, it may take up to two or three months to see improvement in the OCD. Also, ongoing improvement of OCD may continue between I 2 weeks and one year after starting medication.
Optimal duration of treatment for OCD in children is unknown. Many clinicians recommend 9 to I 8 months of treatment after symptom resolution/stabilization, followed by a very gradual decrease in dosage. Relapse upon discontinuation of medications is more common than relapse when cognitive-behavior therapy is used.

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